PT  - JOURNAL ARTICLE
AU  - Oliver C Cohen
AU  - Ananth Sathyanath
AU  - Aviva Petrie
AU  - Sriram Ravichandran
AU  - Steven Law
AU  - Richa Manwani
AU  - Darren Foard
AU  - Sajitha Sachchithanantham
AU  - Shameem Mahmood
AU  - Ana Martinez-Naharro
AU  - Marianna Fontana
AU  - Carol J Whelan
AU  - Philip N Hawkins
AU  - Helen J Lachmann
AU  - Julian D Gillmore
AU  - Ashutosh D Wechalekar
TI  - Prognostic importance of the 6 min walk test in light chain (AL) amyloidosis
AID  - 10.1136/heartjnl-2021-320703
DP  - 2022 Oct 01
TA  - Heart
PG  - 1616--1622
VI  - 108
IP  - 20
4099  - http://heart.bmj.com/content/108/20/1616.short
4100  - http://heart.bmj.com/content/108/20/1616.full
SO  - Heart2022 Oct 01; 108
AB  - Objectives In AL amyloidosis, organ response assessment is based on surrogates (eg, cardiac biomarkers). An objective functional test, such as the 6 min walk test (6MWT), capturing overall clinical improvement, is required. We aimed to evaluate the prognostic impact of the 6MWT at baseline and change following chemotherapy.Methods This study evaluated the outcomes of patients who enrolled in a prospective observational study at the UK National Amyloidosis Centre (2012–2017). Patients underwent comprehensive assessments inclusive of blood testing, echocardiogram and 6MWT at baseline and annually thereafter.Results In total, 799 patients were included within the study. Median baseline 6 min walk distance (6MWD) was 362 m (IQR: 231 m). 6MWD progressively decreased with worsening cardiac disease stage (458 m, 404 m, 331 m and 168 m for cardiac Mayo stages I, II, IIIa and IIIb, respectively (p<0.0001)). In patients with a baseline 6MWT of ≥350 m, the median overall survival was not reached (vs 30.0 (95% CI 23.2 to 36.8) months if <350 m and 5.0 (95% CI 2.8 to 7.2) months if unable to attempt 6MWT (p<0.0001). Following chemotherapy, only patients in a complete haematological response improved their 6MWD by 12 months (p=0.001). Improvement in 6MWD prolonged survival in patients with cardiac amyloidosis (p=0.005).Conclusion The 6MWT is prognostic in AL amyloidosis. A baseline distance of ≥350 m independently predicts better survival. These data suggest that 6MWT has utility in AL amyloidosis for baseline prognosis and assessing response.Due to ethical and confidentiality considerations, data cannot be shared but interested parties may directly contact the authors for any queries.